**2.5 How is T2D treated?**

*Type 2 Diabetes - From Pathophysiology to Cyber Systems*

**2.3 Symptoms and complications**

**2.4 How does T2D diagnosed?**

tests means you have diabetes.

glucose is circulating in the blood.

the body does not fully respond to insulin.

exercise, smoking, stress or sleeping too little or too much.

and lifestyle. Among this category we can find factors such as getting little or no

T2D can evolve moderately during several years. Blood sugar levels stay high all the time when T2D is untreated. High blood sugar levels may cause the following symptoms: thirstiness, frequent urination, tiredness and apathy, fulsomeness and dizziness or even lose consciousness. In addition to T2D symptoms there are complications of T2D containing, five times more likely to get heart disease or have a stroke, dialysis, or kidney replacement in case the kidneys are damaged. Furthermore, high blood sugar can damage the small blood vessels in the backs of the eyes and in cases of neglect, it can cause blindness. Digestive disorders, not feeling of the feet and sexual response are considered as T2D complications as well. Lesions cure slower and can become infected when blood does not circulate well. Miscarriage are more likely in women with diabetes. A condition in which breathing stops and starts while you sleep might developed. It is more likely to have hearing problems. Finally, high blood sugar can damage your brain and might put you at higher risk of Alzheimer's disease.

Hemoglobin is a protein that transports oxygen to the body cells. It can be found inside red blood cells. In cases of high glucose level in the blood glucose can attach the hemoglobin. Hemoglobin that is attached to glucose is called glycated hemoglobin. T2D diabetes is usually diagnosed using the A1C test. A1C test measures the

Red blood cells are constantly dying and regenerating. Their lifespan is approxi-

mately three months. Glucose attaches (glycates) to hemoglobin inside the red blood cells, so the record of how much glucose is attached to the hemoglobin also lasts for about three months. Normally, about 6 percent of hemoglobin has glucose attached. If there is too much glucose attached to the hemoglobin cells, the test results will be high A1C. If the amount of Glycated hemoglobin amount is normal, the A1C results will be normal. An A1C level of 6.5 percent or higher on two separate

The symbol A1C represents a specific type of hemoglobin. The "A" in Hemoglobin A (HgbA) stands for "adult." HgbA can be found in two types HgbA1 and HgbA2. In individuals from six months old about 98% of HgbA is type 1 (HgbA1). Type A1 has subtypes A1A, A1B, A1C, and others. Two-thirds of hemoglobin with glucose attached is type A1C [38]. Therefore, HgbA1C is a good marker for glucose control. Larger amount of hemoglobin will be glycated when more

However, the A1C test results are not always meaningful. For example, when we want to measure A1C difference before and after an intervention that is shorter than three months. The difference of A1C before and after the intervention will not tell us the accurate result because it is an average calculation. In such case we need another test to diagnose the glucose level in blood. Fasting blood glucose test is a blood sample which is taken after an overnight fast. A normal level of fasting glucose is a reading of less than 100 mg/dL (5.6 mmol/L). If the fasting blood glucose is 126 mg/dL (7 mmol/L) or higher, it considered diabetes. Values between 100 to 125 considered prediabetes. T2D is generally characterized by insulin resistance, where

HOMA-IR stands for Homeostatic Model Assessment of Insulin Resistance. Using HOMA-IR equation insulin resistance can be estimated from fasting glucose

amount of hemoglobin in the blood that has glucose attached to it.

**390**

There are two approaches to treat T2D. The first is lifestyle changes and the second is medications. Adopting a healthy lifestyle can help lower the risk of diabetes. Healthy life style contains: lose weight, get active, eat right, avoid highly processed carbs, sugary drinks, and trans and saturated fats, limit red and processed meats, quit smoking and finally work to keep from gaining weight after you quit smoking, so you do not create one problem by solving another. It is possible to reach your target blood sugar levels with diet and exercise alone. However, if changing lifestyle is not enough several medicines exist to treat diabetes. Among the medicine functions are: Lowering the amount of glucose your liver makes and helps your body responding better to the insulin. Helping your body make more insulin, making you more sensitive to insulin. Causing slow digestion and lowering blood sugar levels and finally help your kidneys filter out more glucose.

### **3. Intermittent fasting**

In historical periods in the past when food was not always available fasting was sure to happen. Many religious philosophies have practiced fasting for centuries; however, cyclically restricting or reducing calories has recently taken off as a way to lose weight and improve health outcomes. Intermittent fasting (IF) is proposed as an alternative dieting strategy. IF includes cycles of fasting and unrestricted eating periods, which may allow more flexibility and thereby enhance devoutness [41]. Intermittent fasting is generally grouped into two main categories: whole-day fasting and time-restricted feeding. Both categories range in flexibility of time spent fasting. The details of intermittent fasting interventions which participate in the research described in this chapter are found in the following subsections.

#### **3.1 Continuous energy restriction (CER)**

In a paper from 2011 [42] Michelle Harvie describes a randomized controlled trial to compare the feasibility and effectiveness of intermittent continuous energy (IER) with continuous energy restriction (CER) for weight loss, insulin sensitivity and other metabolic disease risk markers. The CER involved a 25% energy restriction from estimated baseline energy requirements using reported metabolic energy turnovers estimated basal metabolic rate [43] for 7 days per week. The CER group was prescribed a daily 25% restriction based on a Mediterranean-type diet (30% fat, 15% monounsaturated, 7.5% saturated fat, 7.5% polyunsaturated fatty acids, 45% low glycemic load carbohydrate and 25% protein) [44].
